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PubMed2003

Computation of multicenter overlap integrals with Slater-type orbitals using psi(alpha)-ETOs.

Multicenter overlap integrals appearing in the evaluation of multicenter-multielectron integrals of central and noncentral interaction potentials are calculated using complete orthonormal sets of psi(alpha)-ETOs (alpha=1, 0, -1, -2,...). The final results are expressed in terms of two-center overlap integrals between STOs. The convergence of the series is tested by calculating concrete cases for arbitrary quantum numbers, screening constants and location of STOs.

Computers↗
PubMed1988

Intravenous acyclovir therapy of first episodes of genital herpes: a multicenter double-blind, placebo-controlled trial.

PURPOSE: A collaborative multicenter double-blind, placebo-controlled trial of intravenous acyclovir treatment of first-episode genital herpes was performed in order to substantiate previous findings on the efficacy and safety of this drug, to evaluate the influence of parenteral therapy on recurrence frequency, and to obtain further data on the natural history of genital herpes. PATIENTS AND METHODS: Eighty-two patients with first episodes of genital herpes simplex virus (HSV) infection were randomly assigned in a double-blind fashion to treatment with intravenous acyclovir (5 mg/kg every eight hours) or placebo for five days. Before therapy, all lesions in the genital/perineal area and in extragenital sites were cultured. New lesions appearing in both areas after the onset of therapy were cultured separately. Lesions in all groups were cultured until completely healed. Sera were collected from all patients on entry to the study and on Day 21 to determine presence or absence of antibodies to HSV-1 and HSV-2. Time to healing, time to crusting, time to cessation of viral shedding, and appearance of new lesions during therapy were compared for each treatment group. RESULTS: Patients receiving acyclovir experienced a significant reduction in the median duration of pain (4.3 versus 4.8 days, p = 0.019), viral shedding (1.9 versus 8.4 days, p less than 0.001), and time to healing (8.4 versus 11.5 days, p = 0.02) compared with placebo recipients. These differences were largely attributable to the effect of therapy in the subset of patients with primary disease in whom acyclovir reduced the median duration of pain from 10.6 days to 4.2 days, the median duration of viral shedding from 17.1 days to 1.9 days, and the median time to healing from 14.2 days to 8.3 days. The rate of subsequent recurrence of genital herpes was not altered by acyclovir treatment: 24 of 32 acyclovir recipients (75 percent) experienced one or more recurrences during a mean follow-up of 14 months compared with 19 of 27 placebo recipients (70 percent). Among patients experiencing recurrences, the mean number of recurrences per month among acyclovir recipients was 0.25 compared with 0.19 for patients given placebo. CONCLUSION: This multicenter trial confirms the efficacy of intravenous acyclovir in the management of first-episode genital herpes, especially in patients with primary infection. However, therapy did not alter the frequency of recurrences.

Acyclovir↗
PubMed1980

A model for the development, conduct, and monitoring of multicenter clinical trials in the Veterans Administration.

In the past 20-30 years, increased interest on the part of biostatisticians and medical investigators has been exhibited in clinical trial research. In the mid-1940's, the Veterans Administration Hospital system was recognized as an ideal environment for the conduct of multicenter clinical trials, with the initiation of a study to determine the effectiveness of chemotherapy in the treatment of tuberculosis, in a joint effort with the United States Armed Forces. This research effort later evolved into what is presently known as the Cooperative Studies Program of the Medical Research Service. Within the past seven years, this program has undergone considerable growth and reorganization. This paper describes a system for the review, operation, and conduct of multicenter clinical research in a wide variety of medical specialty areas. In particular, it stresses the importance of core biostatistical coordinating centres where biostatisticians and other key support personnel constitute an integral part of the planning and development, implementation, conduct, and reporting of many cooperative studies in diverse disciplines. The paper also describes the interaction of various review bodies and a check and balance system to promote sound management and opportunity for the exchange of clinical and biostatistical methodology in the cooperative study setting.

Clinical Trials as Topic↗
PubMed1981

Organization of multicenter clinical trials.

The typical multicenter trial involves several clinical centers, a data center, and other specialty centers as well. A common structure for large-scale trials funded by the National Institutes of Health (NIH) involves two or three key committees. One of these is comprised exclusively of investigators from the study (steering committee) and is responsible for operation of the trial. A second committee, usually comprised of individuals not involved in the study, is responsible for overseeing the trial and providing advice to the NIH regarding the study. A third committee--sometimes part of the second committee and comprised largely of individuals not involved in the trial--is responsible for monitoring the study results for evidence of adverse or beneficial treatment effects as the trial proceeds. The organizational design of a trial may be as important as the experimental design is in the success of the trial. Attention to organizational questions at the start of the study and periodic review and revision of the structure as the trial proceeds can help identify problems before they become major impediments to progress in the trial. Such ongoing monitoring and periodic review is especially important in the long-term multicenter trial.

Centralized Hospital Services↗
PubMed1986

Adjuvant therapy of breast cancer: compliance and data validity in a multicenter trial.

Multicenter clinical trials are often large and complex, involving many institutions and investigators. The organizational structure is of vital importance in conducting and coordinating such trials. The present article describes the organization of a multicenter trial of adjuvant therapy of breast cancer. The trial is conducted since 1978 and involves all 15 hospitals in the Southern Swedish Health Care Region. The paper also describes methods of determining patient accrual rate, compliance with entrance criteria, diagnostic procedures, treatment, and follow-up. Comparison of data obtained from a population-based regional tumor registry revealed an accrual rate of more than 80%. Compliance with entrance criteria varied between the treatment groups from 85% to 97%. No patients were lost to follow-up. Compliance with diagnostic procedures and treatment was generally good. Reporting of recurrences was in accordance with data from patients' records in 98% of patients. One hundred thirteen patients died during the first 5 years of study. Twenty-one of these deaths were not reported to the secretariat. This strongly illustrates the necessity of matching to a population register before presenting data of such trials.

Antineoplastic Agents↗
PubMed2005

Factors influencing appropriate firing of the implanted defibrillator for ventricular tachycardia/fibrillation: findings from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II).

OBJECTIVES: The purpose of this study was to prospectively examine the role of clinical, laboratory, echocardiographic, and electrophysiological variables as predictors of appropriate initial implantable cardioverter-defibrillator (ICD) therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF) or death in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) population. BACKGROUND: There is limited information regarding the determinants of appropriate ICD therapy in patients with reduced ventricular function after a myocardial infarction. METHODS: We used secondary analysis in one arm of a multicenter randomized clinical trial in patients with a previous myocardial infarction and reduced left ventricular function. RESULTS: We analyzed baseline and follow-up data on 719 patients enrolled in the ICD arm of the MADIT-II study. Appropriate ICD therapy was observed in 169 subjects. Clinical, laboratory, echocardiographic, and electrophysiological variables, along with measures of clinical instability such as interim hospitalization for congestive heart failure (IH-CHF) and interim hospitalization for coronary events (IH-CE), were examined with proportional hazards models and Kaplan-Meier time-to-event curves before and after first interim hospitalization. Interim hospitalization-CHF, IH-CE, no beta-blockers, digitalis use, blood urea nitrogen (BUN) >25, body mass index (BMI) > or =30 kg/m2, and New York Heart Association functional class >II were associated with increased risk for appropriate ICD therapy for VT, VF, or death. In a multivariate (stepwise selection) analysis, IH-CHF was associated with an increased risk for the end point of either VT or VF (hazard ratio [HR] 2.52, 95% confidence interval [CI] 1.69 to 3.74, p < 0.001) and for the combined end point of VT, VF, or death (HR 2.97, 95% CI 2.15 to 4.09, p < 0.001). Interim hospitalization-CE was associated with an increased risk for VT, VF, or death (HR 1.66, 95% CI 1.09 to 2.52, p = 0.02). CONCLUSIONS: These results provide important mechanistic information, suggesting that worsening clinical condition and cardiac instability, as reflected by an IH-CHF or IH-CE, are subsequently associated with a significant increase in the risk for appropriate ICD therapy (for VT/VF) and death.

Aged↗
PubMed1984

Multicenter clinical trial of cefoperazone sodium in the United States.

A total of 187 physician investigators throughout the United States participated in a multicenter trial to evaluate the safety and efficacy of a twice daily dosage of cefoperazone sodium; 91 percent of patients received a dosage of 4 g or less of cefoperazone per day. A total of 455 patients were included in the evaluation of efficacy: 100 patients with lower respiratory tract infection; 146 patients with skin and soft tissue infection; 14 patients with osteomyelitis; 18 patients with obstetric and gynecologic infections; 84 patients with urinary tract infection; and 44 patients with bacteremia. Overall, treatment achieved a satisfactory clinical outcome in 95.3 percent of these patients. Side effects of cefoperazone were evaluated in 659 patients. Prothrombin time increased during therapy in 4 percent of patients, all but one of whom was more than 65 years old. Prothrombin time became normal with the administration of vitamin K. Diarrhea (4 or more loose stools a day) was observed in 3 percent of patients. Other adverse reactions including leukopenia, elevation of serum liver enzyme levels, and eosinophilia were mild, reversible, and typical of beta-lactam antibiotics. These results suggest that (1) twice daily administration of cefoperazone sodium can be used to treat a variety of bacterial infections caused by susceptible pathogens; (2) the adverse reactions associated with this agent at the dosage schedule employed in this trial (2 g twice a day) are predictable and limited; (3) multicenter trials of this type allow for rapid collection of data regarding safety and efficacy of new antibiotics.

Aged↗
PubMed1988

Results of a randomized, multicenter, comparative trial of a single dose of cefotetan versus multiple doses of cefoxitin as prophylaxis in cesarean section.

In a multicenter, open, randomized, comparative trial, 308 women undergoing cesarean section were given a single 1 gm dose of cefotetan or three 2 gm doses of cefoxitin after cord clamping to reduce the incidence of postoperative infectious morbidity. Of the 286 evaluable patients, 195 received cefotetan and 91 received cefoxitin. Most patients were in active labor and one third had ruptured membranes. Microorganisms cultured from the endocervix or intraoperatively from the endometrium or abdominal wall operative sites were comparable for the two groups. In this multicenter study, the difference between the percentage of patients receiving cefotetan who did not develop clinical signs and symptoms of infection (93%) and the percentage of patients receiving cefoxitin (85%) considered clinical successes was statistically significant (p = 0.02, chi 2). The bacteriologic response rate for patients taking cefotetan was also significantly higher than that for patients taking cefoxitin (93% versus 85%, p = 0.03). Isolates recovered from the endocervix, endometrium, or operative site were comparable for the two groups. Both drugs were well tolerated. In this evaluation, cefotetan administered in a single dose of 1 gm was more effective as a prophylactic agent than multiple 2 gm doses of cefoxitin in the reduction of infectious morbidity in this large series of patients undergoing cesarean section.

Adolescent↗
PubMed2006

Stepwise cope rearrangement of cyclo-biphenalenyl via an unusual multicenter covalent pi-bonded intermediate.

Multicenter covalent pi-bonding between pi-conjugated radicals has been recently recognized as a novel and important bonding interaction. The Cope rearrangement of cyclo-biphenalenyl 9 is studied by exploring its potential energy surface with density functional theory (DFT), and it is found that pi-bonding plays a critical role in the rearrangement process. Affected by this, the rearrangement of 9 takes place by a stepwise mechanism through an unusual pi-intermediate 10, of C2h symmetry, which can be characterized as a 2 x 13pi + 2 x 2pi system. The pi-intermediate has a long inter-phenalenyl distance of R approximately 2.8 angstroms, which is shorter than the sum of the van der Waals radii displaying multicenter covalent pi-bonding between the two phenalenyl units. The energy of the pi-intermediate 10 is higher than that of the sigma-bonded reactant 9 by approximately 2 kcal/mol according to the employed spin-restricted DFT. NMR chemical shift calculations support the sigma-bonded 9 as the global minimum. The calculated activation barrier of approximately 6 kcal/mol for the Cope rearrangement is consistent with the stepwise mechanism. A covalent pi-bonding effect in the pi-intermediate 10 is demonstrated indirectly by the shortening of inter-naphthalene distance of the dianion and dication of the cyclophane 14 compared to that of its neutral counterpart. The unusual pi-bonded structure with a long inter-phenalenyl distance becomes the most stable structure for the ethano-bridged derivative 13, which should have observable paramagnetism according to the calculated paramagnetic susceptibility.

Journal Article↗
PubMed2005

Multicenter bond indices as a new means for the quantitative characterization of homoaromaticity.

This study reports the use of multicenter bond indices as a new tool for the quantitative characterization of homoaromaticity. The approach was applied to the series bicyclic systems whose homoaromaticity was recently discussed in terms of traditional aromaticity index, namely, NICS. In this study we found that the multicenter bond indices are indeed able to quantify the degree of homoaromaticity of the studied systems as reflected in the classification of these molecules into classes of homoaromatic, non-homoaromatic, and anti-homoaromatic systems suggested on the basis of NICS values.

Models, Chemical↗
PubMed2000

Prospective multicenter study on urologic complications after radical surgery with or without radiotherapy in the treatment of stage IB-IIA cervical cancer.

A national collaborative group has conducted a multicenter prospective study on the use of a specific glossary for the complications associated with the treatment of cervical cancer, which were analytically described in 1989. This report analyzes the urologic complications with particular reference to radical surgery in stage IB-IIA cancer cases. In the prospective multicenter clinical study 2024 patients with frankly invasive cervical cancer were enrolled (IB = 1041; IIA = 308; IIB = 384; IIIA-B = 237; IV = 54). This report considers 1349 patients with stage IB-IIA disease. Treatment modalities in this group of patients were: type III radical surgery in 21.9%; type III radical surgery followed by radiotherapy in 20.8%; type III radical surgery preceded by radiotherapy in 7.3%; type II radical surgery in 3.1%; type II radical surgery followed by radiotherapy in 8.4%; type II radical surgery preceded by radiotherapy in 18.8%; surgery plus chemotherapy plus radiotherapy in 3.5%; radiotherapy alone in 16%. In this case series 873 complications were registered, and among these 341 (39.1%) were described in the urinary tract. Among 277 bladder complications 47.3% were grade 1; 47.3% grade 2, and 5.4% grade 3. Among 64 ureter complications 59.4% were grade 1; 17.2% grade 2, and 23.4% grade 3. Distribution of severe urinary complications was different according to site (bladder or ureter) and treatment modalities (radical surgery alone: bladder 1.3%, ureter 1.3%; radical surgery followed by radiotherapy: 1.4% bladder, 2.8% ureter; radical surgery preceded by radiotherapy: 3% bladder, 0% ureter). Different distributions of severe urinary complication were also observed in respect to stage (IB vs IIA); treatment: elective vs nonelective. In 673 patients treated with radical surgery plus or minus radiotherapy 123 relapses were registered (18.2%). Incidence of relapse was not different in patients suffering from mild/severe complications vs patients without complications. Disease-free survival, death from tumor, and death from other causes were not different in the group with complications in comparison to the group without complications.

Journal Article↗
PubMed2002

Multicenter randomized controlled trial of the management of unresectable malignant mesothelioma proposed by the British Thoracic Society and the British Medical Research Council.

Malignant mesothelioma is almost invariably fatal. The incidence of the disease is rising rapidly in many countries, and there is no generally accepted standard treatment for patients with unresectable disease. According to current British Thoracic Society (BTS) guidelines, patients should be treated with active symptom control (ASC), involving (1) regular follow-up in a specialist clinic; (2) structured assessments of physical, psychological and social problems with appropriate action; (3) rapid involvement of additional specialists; and (4) parallel nursing support. Although many nonrandomized studies have reported tumor responses to anticancer chemotherapy, few have studied palliation and it is not known whether chemotherapy prolongs survival or provides clinically worthwhile palliation with acceptable toxicity when given in addition to ASC. We therefore plan to conduct a multicenter randomized controlled trial comparing (1) ASC alone, (2) ASC plus mitomycin vinblastine and cisplatin (MVP), and (3) ASC plus vinorelbine (N; Navelbine, Pierre Fabre Oncology, Winchester, UK). We chose these chemotherapy regimens because they have been shown in nonrandomized studies to provide good symptom control as recorded by patients. The outcome measures are overall survival, palliation of symptoms, performance status, analgesic usage, toxicity, quality of life, tumor response, and recurrence/progression-free survival. In a preliminary feasibility study, we are assessing the acceptability of the trial design to patients and the suitability of two standard quality-of-life instruments in mesothelioma. Data will help us to decide the final details of the large multicenter trial.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2026

Integrating Next-Generation Sequencing into von Willebrand Disease Diagnostics: Insights from the PCM-EVW-ES Multicenter Project.

Von Willebrand disease (VWD) is the most common inherited bleeding disorder, caused by quantitative or qualitative defects in von Willebrand factor (VWF). Diagnosis is challenging and requires integrating bleeding history, VWF antigen and activity measurements, FVIII assays, and specialized phenotyping. Genetic testing is increasingly recognized as a key component. Here, we review current concepts in VWD diagnostics and highlight the Spanish Clinical and Molecular Profile of von Willebrand Disease (PCM-EVW-ES) project as a model for genomics-enabled precision medicine. PCM-EVW-ES is a multicenter initiative involving 48 hospitals, centralized phenotypic testing, and next-generation sequencing of the VWF coding region, enabling definitive classification in 730 individuals with VWD to date. Harmonized recruitment criteria and standardized workflows improve subtype assignment, uncover complex genotypes, refine genotype-phenotype correlations, and facilitate the identification of asymptomatic carriers. The PCM-EVW-ES variant spectrum highlights recurrent disease-causing variants in Spain and underscores the value of coordinated national registries for variant curation. Building on these data, we propose a diagnostic algorithm in which bleeding assessment and first-line VWF/FVIII assays, combined with, early VWF molecular testing increases diagnostic accuracy and guides targeted second-line investigations to confirm and refine VWD subtype classification. We also outline persisting challenges, including the interpretation of variants of uncertain significance and patients without identifiable pathogenic VWF variants, and future directions integrating third-generation sequencing, expanded gene panels, functional studies, and artificial-intelligence-driven multiomic approaches. Together, these advances illustrate how robust multicenter studies can bridge the gap between complex diagnostics and clinical practice in VWD.

Humans↗
PubMed1984

Blood glucose control and the evolution of diabetic retinopathy and albuminuria. A preliminary multicenter trial.

We conducted a prospective multicenter randomized trial to determine both the feasibility of maintaining blood glucose control at differing levels and the effect of improved control on diabetic microangiopathy and albuminuria. Seventy patients with diabetes (low C-peptide level) with nonproliferative retinopathy were randomly assigned to continuous subcutaneous insulin infusion or unchanged conventional injection treatment. At entry, both groups had similar demographic, clinical, and glycemic characteristics. Over the succeeding eight months, mean 24-hour glucose concentrations (175 +/- 9 mg per deciliter) and glycosylated hemoglobin levels (10.0 +/- 0.3 per cent) remained elevated during conventional treatment but fell to nearly normal levels (117 +/- 6 mg per deciliter and 8.1 +/- 0.2 per cent, respectively) with continuous insulin infusion. The frequency of biochemical hypoglycemia (less than 40 mg of blood glucose per deciliter) was similar in both groups, but ketoacidosis occurred only during continuous infusion. The level of retinopathy, assessed from photographs, progressed in both groups. Continuous infusion was associated with slightly more deterioration, mainly because of the appearance of soft exudates and intraretinal microvascular abnormalities. In contrast, elevated albumin-excretion rates fell during continuous infusion but not during conventional treatment. We conclude that maintenance of differing levels of blood glucose is feasible in a multicenter trial and that a nearly normal blood glucose level for eight months does not retard progression of, and may initially worsen, established retinopathy. These preliminary observations indicate the need for longer trials (particularly of primary prevention).

Adolescent↗
PubMed2004

Evaluation of multicenter one-electron integrals of noninteger u screened Coulomb type potentials and their derivatives over noninteger n Slater orbitals.

Multicenter integrals over noninteger n Slater type orbitals with integer and noninteger values of indices u of screened Coulomb type potentials, f(u)(eta,r)=r(u-1)e(-etar), and their first and second derivatives with respect to Cartesian coordinates of the nuclei of a molecule are described. Using complete orthonormal sets of Psi(alpha) exponential type orbitals and rotation transformation of two-center overlap integrals, these integrals are expressed through the noncentral potential functions depending on the molecular auxiliary functions A(k) and B(k). The series expansion formulas derived for molecular integrals of screened Coulomb potentials and their derivatives are especially useful for the computation of multicenter electronic attraction, electric field, and electric field gradient integrals. The convergence of series is tested for arbitrary values of parameters of potentials and orbitals.

Journal Article↗
PubMed1996

A multicenter proton magnetic resonance spectroscopy study of neurological complications of AIDS.

Human immunodeficiency virus (HIV) infection as seen in Europe and the United States has predominantly been contracted through male homosexual sex or intravenous drug abuse. In infected subjects, the brain is frequently affected both clinically and neuropathologically. The aim of this multicenter study has been to evaluate the value of single-voxel proton magnetic resonance spectroscopy (MRS) in the assessment of the neurological complications of acquired immunodeficiency syndrome (AIDS). MRS (voxel size = 8 ml, TR/TE = 1600/135 msec) was performed in 137 HIV-1-seropositive patients and 64 healthy controls without risk factors at three clinical MR sites operating at 1.5 T. The first result of this multicenter trial is that good reproducibility of results among participating sites was found. This demonstrates the reliability and robustness of MRS in the study of in vivo brain metabolism. In HIV patients, there was no significant correlation between metabolite ratios of brain detected by MRS and CDC grouping of patients or CD4 count. In contrast, the variations of brain metabolite ratios (NA/Cr, NA/Cho, and Cho/Cr) were related to the occurrence of encephalopathy, brain atrophy, or diffuse white matter lesions. There was no significant difference in brain metabolites between male homosexual AIDS patients and male intravenous drug user AIDS patients, whatever their neurological status (neurosymptomatic or neuroasymptomatic). Thus, the mode of transmission of HIV infection does not appear to affect the cerebral changes observed in the proton spectra from AIDS patients. Because of its ease of implementation and high information content, single-voxel proton MRS is likely to play a significant role in the evaluation of HIV-related encephalopathies.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The utility of a multicenter regional trauma registry.

We report on the experience of five trauma receiving hospitals (four general hospitals and one spinal cord unit) in establishing a multicenter trauma registry (TR) for the purpose of data sharing. To ensure data comparability, all coders were oriented to standard data definitions and injury severity scaling. Coders and their physician sponsors met regularly to review data. Data presented for the four general hospitals from January through September 1992 address comparison of mortality rates, resource implications of isolated hip fractures, and the utility of knowing regional neurosurgical (NS) trauma volumes. Because of a statistically significant higher mortality rate at hospital 2, 7.2% versus 4.7% overall, mortality data were further characterized by patient age, mean ISS, and frequency of severe head injury. This still failed to explain the mortality difference. Hip fractures utilized 11,120 (26.3%) of the total 42,341 TR hospital days. Interhospital differences in median length of stay in this population suggest that greater resource efficiencies can be realized. Earlier questions about the value of including isolated hip fractures in the data set have been answered by understanding the resource implications of this population. Problems of NS coverage arising from a regional shortage of neurosurgeons can now be addressed with a better appreciation of the intraregional differences in NS volumes. Use of congruent data sets, combined with a collaborative approach, has stimulated the application of multicenter TR data to quality improvement, and utilization and regional planning issues.

Abbreviated Injury Scale↗
PubMed2000

Computational method for general multicenter electronic structure calculations.

Here a three-dimensional fully numerical (i.e., chemical basis-set free) method [P. F. Batcho, Phys. Rev. A 57, 6 (1998)], is formulated and applied to the calculation of the electronic structure of general multicenter Hamiltonian systems. The numerical method is presented and applied to the solution of Schrödinger-type operators, where a given number of nuclei point singularities is present in the potential field. The numerical method combines the rapid "exponential" convergence rates of modern spectral methods with the multiresolution flexibility of finite element methods, and can be viewed as an extension of the spectral element method. The approximation of cusps in the wave function and the formulation of multicenter nuclei singularities are efficiently dealt with by the combination of a coordinate transformation and a piecewise variational spectral approximation. The complete system can be efficiently inverted by established iterative methods for elliptical partial differential equations; an application of the method is presented for atomic, diatomic, and triatomic systems, and comparisons are made to the literature when possible. In particular, local density approximations are studied within the context of Kohn-Sham density functional theory, and are presented for selected subsets of atomic and diatomic molecules as well as the ozone molecule.

Computer Simulation↗